Study of IUD insertions and clinical performance in nulliparous women Dr Andrea Brockmeyer Dr Meera Kishen Abacus Clinics Liverpool, UK

Background  Increased interest in IUDs from nulliparous women  Proven efficacy and safety of standard IUDs  No increased risk of PID in nulliparous women

Background No studies about  acceptability  removal rates for pain and bleeding  rate of spontaneous expulsions in the standard IUDs and the IUS in nulliparous women in the UK

Objectives  To assess experience of IUD/IUS fitting and use by nulliparous women (< 24 weeks)

Methodology  Prospective pilot study  Recruitment of 100 nulliparous women at Central Abacus  Routine IUD/IUS insertions or IUD insertions for EC but long-term use  Questionnaire at time of IUD/IUS insertion

Methodology  Follow-up by postal questionnaire or contact by phone three months and one year after insertion

STI screening  Sexual history  CT/GC testing offered if appropriate  Antibiotics (Azithromycin) offered if high risk of CT

Recruitment  Recruitment from May-October 2005  Total recruited  IUD/IUS fitted 118 113  Available for follow-up 112  Failed insertions  Other problems 2 4

Age range

50 40 30 20 10 0 16-19 20-24 25-29 30-34 35-39 Age in years > 40

Reasons for IUD/IUS fitting  EC and long-term use 30 (25.4%)  Interval fitting 88 (74.6%)

STI testing  CT test at fitting  CT test in current relationship  CT test declined 48 65 5  Antibiotics given  No positive CT tests reported 15

Fitting procedure    Local anaesthesia Difficulty sounding Use of dilators 27 (24%) 17 (15%) 10 (9%)  Problems Failed IUD insertion 10 (9%) 2 (1.8%) Client felt faint 7 (6%)

Clinicians impression of fitting  Easier than expected  As expected  Worse than expected 46 (41%) 56 (50%) 9 (8%)

Client’s impression of fitting

30 25 20 15 10 5 0 1 2 3 4 5 6 7 8 9 10

Client’s impression of fitting  Less painful than expected 37 (33%)  As expected 51 (45%)  More painful than expected 22 (19%)

Three-month follow-up (interim results)  No of women contacted  Questionnaire received 112 72 (64.2%)

Problems   No, not at all Yes 23 (32%) 49 (68%)  Symptoms but not a problem 10

Abnormal bleeding  Abnormal bleeding  Periods heavier -Unable to cope  Intermenstrual bleeding  Postcoital bleeding  Other 46 (63.8%) 39 (54.1%) 4 (5.5%) 21 (29.1%) 5 (6.9%) 8 (11.1%)

Pain  Pain  Periods more painful  Dyspareunia  Other - pain between periods - constant pain 45 (62.5%) 35 (48.6%) 10 (13.8%) 13 (18.0%) 11 2

Pelvic infection  Pelvic infection 1 (1.3%)

Have you still got your IUD/IUS in?

  Yes No 65 (58%) 7 (6%) (+3 removed in 3/12)     Expulsion Removal 3 5 - Bleeding 2 - Pain 3

Satisfaction with IUD/IUS

18 16 14 12 10 8 6 4 2 0 0 1 2 3 4 5 6 7 8 9 10

Conclusion  In general, IUD/IUS fittings well tolerated  Majority of women satisfied with device  NICE Guidance: All women should be given full choice of methods incl. IUD/IUS  Numbers too small to compare devices